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NPI Code Detail

MEDICARE: MRS. CHARISMA LYN QUIAMBAO FERNANDEZ OTR

MEDICARE: MRS. CHARISMA LYN QUIAMBAO FERNANDEZ OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT12516FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OTR12516OTHERFLOCCUPATIONAL THERAPIST

General Provider Information

NPI Number : 1245354380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHARISMA LYN QUIAMBAO FERNANDEZ OTR
Provider Business Mailing Address
First Line : 875 WILMETTE AVE APT 715
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-9517
Country : US
Telephone Number : 407-683-2020
Fax Number :
Provider Business Practice Location Address
First Line : 170 N CENTER ST
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-5186
Country : US
Telephone Number : 386-672-7113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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